ER s11e19 Episode Script

Ruby Redux

E. R. Previously on E. R. - What do you want me to call you? - How about introducing me as "Abby"? You don't want people to know we're going out. - I'm Dr. Pratt. - Olivia Evans. I'm with Ceasefire. - Ceasefire? - Violence prevention program. What's she like? She's a health professional, Ray. Don't be such a dog. Where did this happen? - Twenty-third. - Wabash. Well, it- It was near the corner. - Did you file a police report? - What's the point? She and her sister panhandle on Wabash. I give them a buck once in a while. I need this publication for my Chief Resident application. Trust me. It's gonna take a hell of a lot more than that. E. R. 11x19 "RUDY REDUX" SubtÃ­tulos subXpacio Yeah, I called Sid. And, no, he doesn't have anything new to show us. We need a new realtor. He's shown us 17 houses - not one of them close. - Don't think the problem could be us? All right, what about this one? No. It doesn't seem fair to schedule it like that. You work all night, now you gotta rush back. You're tired. What do you mean, I'm tired? Do I look like I'm tired? Of course not. No. You look chipper. It's just- - Smoodge. - You're just- You're worrying so much. You know, they don't schedule tenure meetings around the candidates. Hey, at least you're overthinking the wardrobe. I am not worrying. And I am not overthinking. You know, tenure means financial security. We could get a house, start a college fund for Cosmo. What if Cosmo doesn't want to go to college? - What? - Baby, I can go back to work. - I know. - You can make more at a private hospital. No. It's not about the money. I want to be at County. It's where I belong. Okay. I'm gonna leave these here. Promise me you'll step over them. - I promise. - All right. I gotta go, baby. I love you. And you too. - Oh, Susan. - I have one meeting, then I will be home. - Susan. - How do I look? You look great except just: Smoodge. Jules Rubadoux, 85. - Who are you? - I'm Dr. Rasgotra. You're a doctor? You got a high school diploma? Eighty-five, fainted. - I did not faint. I was tripped. - It was witnessed. Syncopal event at his club. Unconscious 30 seconds. Who told you that? Those old geezers? They're unconscious most of the day. - Must've been a long ride. - Oh, tell me about it. Get out of here! Bring back the omelet! - Okay, we'll see what we can do. - Now! Delirium, tachycardia, hyperthermia, mydriasis. - Better not have spinach! - What do you think? Don't get high by snorting antihistamines? I hate spinach. Come on, guys. This is classic. Mad as a hatter, red as a beet - Dry as a bone. - Anticholinergic toxicity. Bingo. What's your plan? IV, tox screen, activated charcoal. - Yes. What else? - EKG, rule out cardiac effects. - Ativan for the agitation. - Excellent. And what happens if the delirium worsens despite benzos? Physostigmine. The only acetylcholinesterase inhibitor that crosses the blood-brain barrier. Everybody get that? Where do I sign to get out of here? We need to examine you first. If I wanted help, I wouldn't come to this place looking for it. - I want another hospital. - We're just gonna check you out. - I don't want this place. - It won't take long. - I don't want your doctors. - Dr. Carter, we need you. - Okay. - Especially that one. I don't want that one anywhere near me. He killed my wife. Sam, what's the deal with my lymphoma guy? CT was ready for him 40 minutes ago. Man, I totally spaced. I'll go take him. Don't bother. They got a seizing ICU player. Be backed up a while. Okay. - Crap. Sorry. - That was the Guatemalan blend. - I said sorry. - Come on. Let's move some bodies. Transfer from Seashore House, fever and incontinence. I got stuck with the last dump. Abby, I'll trade you. Whatever you get. - No, Ray. I don't think so. - Neela, 85-year-old man with syncope. - The one you brought in. - The guy that yelled at Carter? Afraid so. And as much as I hate doing this to you, I'm out of here. Exam 3. I've served on the curriculum and admissions committees for three years. And we appreciate that. We're also looking for excellence in teaching. You've won the Resident teaching award three years running. - That's very impressive. - Seven years as an Attending - only four publications? - No original research? First author? I just submitted a review article. And I have other studies lined up. - I'm waiting to hear about the grants. - Emergency medicine's a smorgasbord. Sometimes it's hard to find your niche. Excuse me? The university is willing to float junior faculty for a few years. But- Tenured Attendings need the ability to carry their own weight. You mean, bring in grant money. Okay, my focus hasn't been research. I've spent the last seven years becoming a good clinician and teacher. That's clear, Susan. And we put a great deal of value on that. Well, I don't want you to do anything until I can talk to my own doctor - Stanley Obermeyer. - Right. We have a call in to him. Yeah? Well, Stanley's not gonna like what you guys are doing, prodding me here. Mr. Rubadoux, I can't hear while you're talking. - You've been listening for 5 minutes. - You've been talking for 5 minutes. - Anyone ever tell you you have a murmur? - A what? A murmur? The sound of blood rushing through the heart. - You think I have that? - I'm pretty sure, yeah. Oh, "pretty sure"? Is that all you can say? I'd like to run some tests. - What tests? - EKG, chest x-ray. Draw some blood. Look, no offense, but I don't want some nurse calling the shots around here. Mr. Rubadoux, I am not a nurse. I am a doctor. Well, you're not my doctor. And I'm not gonna let you do anything else until I talk to him. - Okay. - Okay. Jeez. - I'm Dr. Pratt. Take a deep breath for me. - Sats 88 on a nonrebreather. - Is he dead? Is my husband dead? - Behind us. Doctors are working on him. He's alive? Wife fired a couple of rounds to his chest. Pulse at 133, BP, 90 palp, went apneic in the rig. - Access? - Two large-bore IVs. Liter en route. - Another day, another happy couple. - All right, on my count: One, two, three. - Two of Versed right away. - Your husband stabbed you? He cornered me in the kitchen, had a knife to my throat. - Definite ETOH. - Have you been drinking, Mrs. Casey? I didn't know what to do. I grabbed his gun from the kitchen. Decreased breath sounds. You have a collapsed lung. I need to reinflate it. Sam, you were supposed to check the airway boxes. - I don't think so. - According to the schedule. - I thought it was Malik's turn. - We're out of 8.Os. - Malcolm, who's sorry now, you bastard? - What did you do? Take a vacation? Not my fault Sam didn't stock the shelves. - Tube. - I can barely palpate a femoral. Heart rate's up to 140. Okay. Hang the O-neg and call for type-specific. - Ray, he needs an IJ. - And a surgeon. O.R. 3's on hold. You got this? I need to check next door. - How's she doing? - Her lungs are down. She's stable but she's agitated. Sam, where's that Versed? - What are they doing? - Here you go. - I was getting it. - Okay. I was just right here. - I've got it covered, Luka. - Okay. They better not send him home. I'm changing the locks, not gonna let him in. Mary, you need to calm down and answer some questions for me. - Where are you? - Some hospital. - And what year is it? -2005. - Good. And where do you live? - West Garfield. West Garfield? Do you got a problem with that? Bilateral crackles, 3/6, harsh systolic murmur JVD and the liver's down four centimeters. You heard him. He doesn't wanna see me. - Why don't you present to Kovac? - Tied up in a trauma. We're waiting on call from his doc. I got him to calm down by promising to bring in an experienced physician. - Which means an Attending. Means you. - All right. Any cardiac history there? Chronic CHF and evidence of an old infarct. I sent off troponins. I'll get an EKG when you're done. And did Obermeyer call yet? Hello. I'm Dr. Carter. Don't worry. I remember your name. Ten years, I don't forget. - I understand- - You remember my name? Rubadoux? - That's a very unusual name. - You don't even remember. And you don't remember my wife then either, do you? Just some other old person. Give them the old song and dance and ship them off. Okay. We need to hear from your doctor. So in the meantime- I knew she didn't have much time left. But why did you have to put her through all that? My sweet Sylvie. Keeping a smile every step of the way. - Let's take a quick listen. - No, no, no. I want my own doctor. Mr. Rubadoux, he's the Attending. He has to examine you. What do you mean, "has to"? What is there, a law around here a rule when you come into this place? Yes. Actually, there is. All right. Make it fast. What was that about? A very unsatisfied customer. - He needs an echo. - I called Kayson. He's on it. Radiology called about that kid with the huge head. - Hydroceph-? - Hydrocephalus, yeah. I'll call Neurosurg. - Even more of a handful than before. - You remember him? Don't let him get to you, Carter. It was a long time ago and you were just a student. Dr. Lewis, thought you were off. What are you doing? - Don't ask. - Been paging you. I was in a meeting. I turned my pager off. Got a double trauma. Long as you are here- - I'm not here. - The meeting got changed to 3:30. - What? - That's why I've been paging you. I just worked all night. I can't stay till 3:30. "Rubba-ducks"? Rubadoux, Sylvie. How long will this take? Ten-year-old chart? Could be a while. I'll wait. Certainly thinks highly of you. Well, that's very flattering coming from him. Oh, and don't get me wrong. He was brilliant. But he drove us crazy. Made us do a full workup on every single sniffle. Well, that's my Dr. Obermeyer. Nothing if not thorough. - Dilated left ventricle, gradient's 86. - Those calcifications? I'm listening to the doctor, please. Ejection fraction's only 45, but seeing as he presented with both syncope and failure, there's really only one option. Mr. Rubadoux, you have critical aortic stenosis. One of the valves in your heart is narrowed. - We have to operate to open that valve. - Operate? - When? - Well, as soon as possible. Your heart's not generating enough force to push blood through that constriction. And you can do something about that? Well, we have to run a few tests. But, yes, we can. I'll talk to Anspaugh. You check his BUN, creatinine, order PFTs. - Hang in there, Mr. Rubadoux. - Call me Ruby. Ruby. Hey, pretty lucky, huh? Same school as my doc. Nothing personal but they both have a little bit more water under the bridge - if you know what I mean. - I know what you mean. - Did you understand everything he said? - Yeah. Yeah, I need a heart operation. Do you have any questions? - Heart surgery's a big deal. - I know that. What, am I an idiot? Well, do you also know that, given your age the risks of surgery are higher? - What risks? - Complications. I mean, I need to get some more information on your lung function and your kidneys. - Something wrong with my kidneys? - No. I don't know. I don't know yet. Yeah. Well, why don't you come back when you're less confused. Okay. Mr. Rubadoux, I just want you to understand that this surgery is very serious. And that we don't know yet if you're even a good candidate. And that it's important you consider all of your options. Listen, doll can you fix my heart? No. Then I'm going with the guy who can. All right? Bye. Prior Ml, marginal ventricular function, and his creatinine's 2.3. He's 85. He has significant coronary-artery disease renal insufficiency and a history of COPD. - What do you think about his lungs? - We can check his PFTs, but he's old. - They're not gonna be perfect. - Anything else you want? Send coags. Have him typed and crossed. Excuse me. I'm sorry, but don't you think, just maybe open-heart surgery might not be such a good idea for this man? Don't you think just maybe that's the surgeon's call? Actually, no. I think it's the patient's call. He could spend the rest of his life on a beach in Miami - or hooked up to a ventilator. - He wants the surgery. She's trying to advocate on behalf of her patient. CICU's full and Mr. Rubadoux needs a bed. She could advocate for him there. Anspaugh's on his way down. What? - So how's it going in there? - I'll take a 12-year-old gangster over a domestic-violence case any day. She said she was from West Garfield. I figured I should give you a call. But I wasn't sure if this was a Ceasefire kind of thing. Every shooting is a Ceasefire thing. If she gets out of this mess, there's a lot we could do for her. I don't know. She seems pretty far gone to me. - How do you stay so optimistic? - How do you? What? Stay optimistic? I don't. Three years in this place, I'm jaded as hell. You just saw a drunk, battered woman who shot her abusive husband - and saw some hope in the situation. - I did? You wouldn't have called me if you didn't think I could help. I see right through you, Dr. Pratt. Is that right? We'll follow up with her after she's discharged. - So that's it? You're done? - For now. Shouldn't you stick around? She's bound to have questions - once sedation wears off. - You can handle it. But I don't know too much about domestic-violence counseling. I would love to give you a lengthy tutorial - but I'm out of time. - How about later? You can school me over dinner. Pick me up at the office at 7. - Is this gonna take long? - We've already been here quite a while. We'll need to be going soon. You had a low-grade temperature when the nurse took it earlier. Beautiful girl. - Caramel skin. - Like a young June Allyson. - Maureen O'Sullivan. - Susan Hayward. - Ava Gardner. - Myrna Loy. - Sophia Loren. - Sophia Loren? Okay. I heard some crackles on the right side. Could be a sign of a lung infection. - You'll need to have a chest x-ray. - Crackles? - The other doctor didn't mention crackles. - No. That's right. You were in here over a week ago. You saw Dr. Lockhart? Lovely woman. Like a young Patty Duke. Now, your aortic valve right here is stiff and stuck shut. What we're going to do is cut out all of the stenotic material and replace it with a porcine valve. So it's definite he's having surgery? It is. Isn't it? I mean, it's- It's the only way to go, right? We could treat you with digoxin and diuretics, but that would be short-term. At this stage, surgery's the only definitive treatment. Just so you know, Dr. Anspaugh, his FEV 1 is only 53 percent. - Thank you. - Make him NPO after midnight. And don't his decreased lung capacity and renal insufficiency strongly con-? What I mean is, shouldn't we be discussing the risks? Yeah. But we talked about all that. The risk, the complications, the kidneys. We're going to talk about them again, Mr. Rubadoux. Call me Ruby. - Will you excuse me for just a minute? - Certainly. Dr. Lockhart. I take it you have a problem with Mr. Rubadoux's decision to have surgery. I'm concerned it's not an informed decision, yes. And is that because you failed to adequately explain the risks? Do you think I would operate on this man if he didn't understand the consequences? Why would I do that? Because I have nothing better to do? - No, certainly. - If you have concerns you ask the consulting doctor to step outside. You do not, in front of a patient, attempt to subtly disagree with the senior cardiologist and the chief of surgery. That kind of behavior is helpful to no one. - Do you understand? - Yes. I have concerns. Knowing you as well as I do I'm gonna guess you really hate it when people do this. The come-from-behind- and-put-your-hands-over-the-eyes thing? Yeah. Words cannot express exactly how much I hate it. Pretty cool that I knew that, don't you think? - Bad timing? - Yes. - Want to talk about it? - No. So I'm back. Oh, my God, Jake. I'm sorry. I'm sorry. - It's okay. - How was San Francisco? Amazing faculty. Lots of O.R. time. I thought Boston was first until I saw UCSF - but it's a long shot. - They wouldn't have invited you if they weren't interested. Where's Carter? - MRI. - Thanks. So UCSF, huh? Yes. I liked it. But, you know, I still could match right here. - Yup. - What would happen if I did that? Well, Jake, then you'd be working at County. Dirk Harmon, 14. Crashed headfirst into a retaining wall - while luging down Sheridan Road. - Luging? Street luge. Don't you watch those guys on ESPN? - When do you watch ESPN? - Pulse, 72. BP, 112/65. Sats 100. I'm Dr. Pratt. How fast were you going? - Forty, maybe 50. - All right. - Come on, you guys. - He's one of the qualifiers at Super Mass. But I'm really more into dual. - Where do you find hills in Chicago? - Luka. - You do snow too? - Totally. Hello, everyone. He just rammed his head into a wall. - Yes. - Yes. - Hey, dude. My hands are numb. - Weird. - When did that start? - Just noticed it. Pratt, hold the C-spine. Let's move him carefully. Hey. I need to talk to you about the Rubadoux thing. Birdy Chaddock, 72-year-old female with cough and low-grade temp. Sats fine. No shortness of breath, right middle lobe infiltrate on the film. She was your patient last week so perhaps for continuity of care - In with the same thing? - No. Had facial contusions. - Her sister was with her? - Oh, yeah. She's here this time too. She's got family support. Treat her like an outpatient, send her home. - They're panhandlers. Both. - Everybody's gotta make a living. What is wrong with you? - She won't get better on the streets. - Call Social Services - hook her up with elder assistance. - They did express interest in leaving soon. Call Social Services. Okay, about Mr. Rubadoux. Nobody is painting him a clear picture. Surgery is a lousy choice. - His choice. - He does not have an objective view. Seventeen-year-old, avulsed finger. Sign so we can treat without the parents. - How'd he do it? - Slammed his hand in the car door. - Somebody needs to talk to him. - You're his doctor. You're the Attending. He's old school. He needs to hear it from a guy. It's that time. Girl Scout cookies. I'm feeling the pressure. - Okay. - We'll find you later, all right? - Just - Okay. What is going on with you? Why keep blowing this off? - I'm not. - You tried to stop our conversation to buy Girl Scout cookies. - Talk to this guy. - I'm not the one to do it. Okay. I don't know exactly what went on between you and him, but right now- Look. Once in a while you're gonna find these old guys that would rather be treated by a gray-haired guy with a white coat. - Figure out a way of getting to him. - Been trying for an hour. He's a wall. Well, then you did your job. Move on. Dr. Lewis? - Dr. Lewis? - Yes, Jerry. Are you sleeping? Probably not, huh? The Chief Residency meeting is starting. Thank you, Jerry. Are you really up? Because I have to leave now. Yes, Jerry. Eighteen hundred Solu-Medrol going in. - What do you got? - Keep your eyes closed, Dirk. Traumatic C-spine injury. I didn't wanna just yank the helmet off. Pretty cool, huh? Dude, one move, they'll slice through your head. Shut up, man. This is gnarly. Compared to the Gravity Games, this is nothing, man. Except for a little cord compression. Anybody seen Carter? He's probably at the meeting where Luka and I are supposed to be. Anspaugh wants a central line on our aortic-stenosis patient. - Pratt, go help Abby. I'll finish that. - Okay. Sterile 9s and prep for a cordis. - Nice suit, Morris. - Thank you. It's important for the Chief Resident to project a certain professionalism. And I must say, life in the ER doesn't offer enough opportunity to dress up. - Sorry I'm late. - You haven't missed anything. Dr. Lewis, if you don't mind. The lights, please. "CHIEF RESIDENT" The Chief Resident in a busy, urban ER must wear many hats: Teacher, mentor, counselor, friend. SCHEDULING TASK MASTER - Over the course of the next hour - Hour? I will review my proposed strategy for making the Residents' schedule and address how the new ACGME/RRC work-hour mandates apply. I will also identify common stumbling blocks that may affect the schedule and present my patented win-win approach to problems and changes. Next slide. You can't just leave. Oh, yes, at our age we can. I'm sorry Social Services is backed up but we need them to see you before you go. We saw them the last time we were here. Lovely woman. - Oh, a regular young- - No, no. God, no, please. - Please, just- - Dr. Barnett, we are grateful. And we're gonna do the best we can. But it's important that we leave now. We cannot miss the rush hour at the El. And if it gets you in any kind of trouble, I'm so sorry. - We could write you a note. - A note? It's not gonna be good enough. You see last week, two of my other patients, they left on me. And my boss is really unhappy with me. He says if this happens again, they're gonna send me to- - Away? - Well, to the morgue. - The morgue? - Yeah. It's a big demotion. - He's clever. - Oh, yeah. You gotta give him that. Page me from MRl. I wanna see the scan. - Sam, what's going on? - Nothing. I'm cleaning up and restocking. - Is this about the luge boy? - You were encouraging him. - I wasn't. - Pratt and Ray, that I can understand. Sam, I wasn't. And you're overreacting. A little bit? I'm just having a bad day. I have a headache. Just- Hey, just tell them you wanna leave early. - I'm fine. - No, really. Tell them you wanna go home. If there are any complaints, they can talk to me. Okay. - You're okay. - I'm okay. Okay, aim your needle inferiorly. And watch the screen as you enter the vein. How are we doing, Mr. Rubadoux? I don't know. You tell me. - Doing just great. - Got a flash. Guidewire. - What is that? What's going on? - It's okay, Mr. Rubadoux. - Throwing PVCs. - Pull back. - Run of V-tach. - Pull back. Yeah, I am. I'm nowhere near the myocardium. I don't feel right. - V-tach again. - All right, I'm coming out. - What's happening? - Hang in there. - A hundred of lido. - Mr. Rubadoux? Mr. Rubadoux? All right, let's get him into a trauma room now. Come on, let's go. With the Morris-modified circadian scheduling system we can build needed flexibility into the program. A sample sequence might go like this: Three days, two off, three evenings, two off, three nights, two off- - 911. It's the ER. - Liar. - Morris, I apologize. - I'll put a hard copy in your box. - That would be great. - Get on with it, Dr. Morris. Three nights, two off, and repeat until the end of the block. Next slide. Good news. Social Services is- - Hello. - Hi. This is our niece, Shelley. I just found out they were here. Thank you for taking care of them. - We wanted to leave, didn't we, doctor? - Yes, we did try, right? - You made- You made us stay. - Yes, I did. So now Shelley's here, we can go with her. - No, no, no. You have to wait- - Could we talk? Oh, yes. Go ahead. That's fine. Okay. Listen, we're waiting on Social Services to come down here. Yes. And they're wonderful. They've been so helpful. But, you know, it's been a long day and they're both - They're really getting tired. - It shouldn't be too much longer. They're both so stubborn those two. I- I've been trying to get them to move in with me. You know, they just- They want their independence. So they can panhandle. Isn't that unbelievable? Yeah. I told them that I could get them right home, into a hot bath. Our oldest moved in with her boyfriend. We've got the extra bedroom now. I just- I've tried everything. I don't know what else to do. I don't know how to make them accept some family support. Okay, let me talk to them, all right? Okay. Birdy? Rebecca? - Still V-tach. - All right, another epi. Chase it with lido. All right, switch out. Set up to intubate. - What happened? - A central line. It was fine until he started having runs of V-tach. - Must have an irritable myocardium. - Three-sixty. Clear. No change. - Why is Anspaugh opening this guy up? - Critical AS. - Epi's in. - Move that. Man can't tolerate a central line, he isn't gonna do well in the O.R. - He wants the surgery. - So what? - So we're giving it to him. - Those guys got nothing better to do? Damn it. I think I broke his rib. All right, clear. - Normal sinus. - That's what I'm talking about. The Chief Resident position is 90 percent administrative. Morris can handle that. Yeah. But even the med students think he's a joke. - We should get someone from the outside. - It's very difficult on the staff. You came from the outside. - How did the Morris meeting go? - You missed a fascinating lecture on circadian scheduling. - We're not giving it to him though, right? - Considering it. - You out of your mind? - If you don't show up- I was in a trauma. What did Carter say? We should vote. - You can't. You weren't there. - I don't care. On 36 hours. I have to go. - And I'm late. - John. - What happened on the meeting? - I don't know. I left. - Kerry's leaning towards him. - Yeah. Well, okay. "Well, okay"? We've had worse. - Don't think so. - Then maybe she won't give it to him. Hey, Frank, can you come and find me when the labs are back on Gase in 2? Yeah. Got it. You were gonna take that haggard mom, five kids, Exam 3. Rubadoux's back, complaining about his tube and telling the nurses no Jell-O. Good. I told Kayson and Anspaugh about the ribs and the resultant pneumothorax. - What about the surgery? - Not right away. They're going to stabilize him in CICU for a few days, let the pneumo resolve. But everyone remains hopeful. We're just waiting on a bed. DON'T SHOOT. I WANT TO GROW UP. - Can I help you? - How you doing? Looking for Olivia Evans. - I'm supposed to meet her. - She's in the back. - Follow me. - Okay. Three grandmothers reclaimed 78th and Hermitage by opening a bakery. Turned one of the roughest corners in our city into a coffee klatch. Dr. Pratt, just in time. Everyone, this is Greg Pratt. He's an ER doc at County. - Hello. - How y'all doing? Dr. Pratt gets to see how senseless shootings are overwhelming our city's hospitals. And we were just talking about various job opportunities in the neighborhood. So maybe you'd like to say something about jobs in health care? - Felix, get back here. - This is for Tasha's ear infection. - Twice a day for a week. - Holly's the one with the ear. Right. Tasha has the eczema. Apply to the affected area three times a day for a week. - Just like the ears. - No. Ears twice a day. Rash, three. Found him. He was running off with your hammer. Thanks, Chuny. Just a minute. - I'm gonna go. Good night. - I could use a little help here. One, two, three, four, five. I'm off. I'll be home by 8. You wanna grab a dinner? I'm kind of beat. Maybe stay in tonight. Okay. See you later. Good night. - Coffee? - Yeah. Sorry to hear it. - Really awful this time of night. - Oh, I know. "EMERGENCY" When I was a student on my surgical rotation, Rubadoux's wife was very sick. She was part of this research study. When her results- When she wasn't useful, there was pressure to get her out. So I did. I dumped her into a nursing home. Did she belong in one? We all figured she'd end up back in the hospital. But she'd be on the Medical Service and not ours. So Surgery dumps another patient on Medicine. Happens every day. I told Rubadoux that she was gonna get better. I told him that her situation was gonna improve. I told him what he wanted to hear. You know, when you're a student you're so desperate for approval. You want patients to like you, their families to like you. You gotta be efficient too, though. You gotta impress your superiors. You don't have to tell me. I'm still on the bottom rung of the ladder. When the Chief of Surgery says, "Get rid of her," you do. Yeah. And then she came back about three days later and she died and Rubadoux was so surprised. Ultimately, it was the Attending's call. Wasn't my responsibility. You wanna help with this? - All right. - Take it easy, man. You too, man. Right. One of my guys has a real thing for science. I could bring him to County, have you show him around. Sure. Never been out of the neighborhood. - Don't realize there's a city. - I know. I was 10 before I saw Lake Michigan. You from Chicago? Any relation to Charlie Pratt? Charlie Pratt who works for Parks and Recs over on Lamont? - Yeah. The older fellow. - I don't know him. Hey, that was a really nice meeting tonight. - I gotta run. - Okay. - It's nice meeting you. - You too. You're still speaking to me. - Yeah, I think so. - I'm not sorry. I want you to see what we do. You'd never come on your own. And I'm not apologizing about the tuna casserole. But since you're being such a good sport, I'm willing to buy dessert. So ice cream or key-lime pie? - I'm sorry. What? - Dessert? Past your bedtime? No, no. It's just that I have this patient I have to check back on in the ER. Well, then, I guess- I guess you'd better be going. I'll call you. "PREGNANCY TEST" Fifteen ninety-five. Where you going, Ray? Look, I know I'm on for another half-hour, but I have taken care of everything. Filled in Abby on all my cases. Is Abby your Attending? Right. Ulnar fracture up getting casted in Ortho. Malignant otitis admitted to ENT. Tongue lac wants a vasectomy, you know, as long as he's here. Gonna follow that up with Urology. Oh, and the Olsen twins. They decided to leave with their niece and a Z-PAK. Follow-up in a week. What did Social Services say? They actually didn't make it down. I mean, in time. But you released them anyway? I felt they had a strong family support system. These are the panhandlers, right? You felt comfortable releasing them to a family member who obviously hasn't been much help so far. Their niece, yes. She admitted it's been hard getting them to accept help. - They are moving in with her now. - Is Social Services going to follow up? I mean, seeing as how you prevented them from doing their job today. I will make those arrangements. I need to know everything. I need to know the status of every one: How they are, where they are, where they're going, why they're going You're still an intern, Ray. I'm the Attending. I'm responsible. I'm sorry. - Hernia guy's HMO is refusing to cover. - He's not stable. - I'm not discharging. - You wanna tell them? - I'll call. - Sedation for Mr. Garrity. - Kovac was there. He can sign them. - Okay. Won't believe this. Your tibial fracture's - requesting an organic cast. - I'll be right there. Mr. Rubadoux? I'm not feeling well. So if you don't mind. I just wanted to say that I'm sorry. I couldn't believe it when I saw you. You're still here. Been 10 years since my My Silvie's gone and you're still here. Yeah. And you didn't even remember. Oh, well. They gave me six other doctors so I won't need you this time. I made a mistake with your wife. And I made a mistake with you. You don't think I know that? You don't think I regret ever bringing my poor Silvie down to this damn place? You and your fancy tests. "We'll put her through this. We'll put her through that." "Oh, Sylvie? Oh, she'll practically be back on-stage dancing again." - Well, we did try. - You tried? You tried? It became a very complicated situation. And I didn't have the experience to handle it properly. All you had to be was a human being. You lied to me. And I believed you. My Silvie. My Silvie. She was really something. Mr. Rubadoux what you have wrong with you, aortic stenosis can oftentimes be corrected with surgery. But that doesn't mean that that's the right thing for you to do. You're 85 years old. You have chronic respiratory problems. The chances of you coming through surgery and getting back to the shape that you're in right now: Pretty slim. If you go ahead with it, there is a good chance that you will never leave this hospital again. You'll be connected to a ventilator and you will live out the remainder of your life in the Intensive Care Unit. Now, without the surgery, it's true, you're not gonna get any better. But I believe that you will leave this hospital under your own power. And you will have more time with the people that you love. You will have more time being the person that you are today. And, yes 10 years ago I lied to you about your wife. But I am not lying to you right now.